Hospital at home works for many older people

Receiving care at home is a good alternative to hospital for many older people, according to research funded by the National Institute for Health and Care Research.

The service, called hospital at home, led to no more deaths after six months or a year than among people admitted to hospital. People receiving the service were less likely to be admitted to a care home (a sign they are not coping at home), and it was cheaper than hospital care. In addition, people and their carers preferred it to hospital care.

Some areas in the UK already provide hospital at home for older people. The service is led by a geriatrician working with a team of different NHS specialists. Without such a service, some of these people would have been admitted to hospital.

The study explored whether hospital at home would allow older people to remain in their homes for longer compared to hospital care. It explored the costs of the service and whether it helped people to recover from illness. The team interviewed older people and their caregivers to assess their experiences of the two services.

The study included 1,000 people in nine locations across the UK. It included people aged 65 and older who were being considered for a hospital admission. One group of participants was admitted to hospital, the other received hospital at home (homecare). Homecare included a complete geriatric assessment along with care from different NHS specialists. All participants had access to hospital-based services when needed (including admissions), and primary care.

Six months later, people in both groups were similarly likely to be living at home (79% homecare; 75% hospital). This was also true at 12 months (66% homecare; 67% hospital).

The study also found that:

• a similar proportion of each group had died at 6 and 12 months
• slightly fewer people in the homecare group were admitted for long-term residential care at 6 and 12 months
• both groups had similar problems with memory and concentration (cognitive impairment) and carrying out daily activities at 6 months
• people in the homecare group had less risk of sudden confusion (delirium) at 1 month follow-up than the hospital group
• people in the homecare group were more likely to be transferred to hospital after 1 month, though by 6 months transfers to hospital were similarly likely in both groups.

The researchers took into account NHS, personal social care, and informal care costs. They concluded that homecare (hospital at home) could be a cost-effective alternative to hospital for older people. It was not suitable for all older people, such as those who are most seriously unwell.

‘The current national strategy of pouring most of available funding into acute hospitals is failing. Excess deaths of people at home are nearly one-third higher than the five-year average, and unmet need, ambulance response times and waiting lists for treatment are at record levels,’ said Jane Townson, chief executive of the Homecare Association.

‘We call on the government to invest more in home-based and community support and care, to shift the dial on demand, improve our health and well-being, and reduce costs. As well as improving lives, this would also help to support economic recovery.’

Photo by Claudia Love